Arterial Stiffness Assessed by Brachial–ankle Pulse Wave Velocity Predicts Functional Dependency in Community-Dwelling Older Japanese Adults: The Wakayama Study

Objective: Arterial stiffness represents the cumulative burden of vascular aging and hypertension-related damage. Brachial–ankle pulse wave velocity (baPWV) is a well-established non-invasive measure of arterial stiffness and a predictor of cardiovascular outcomes. However, its prognostic relevance for future functional dependency in older adults has not been fully elucidated. This study investigated the age-stratified association between baPWV and the 5-year risk of incident functional dependency in community-dwelling older adults. Design and method: We conducted a retrospective cohort study including 852 adults aged 65 years or older (mean age, 72.0 ± 4.4 years; 43.7% men) who participated in health examination surveys in Wakayama, Japan, between 2017 and 2018 and were followed for 5 years. Participants were stratified into early elderly (younger than 75 years) and late elderly (75 years or older) groups and further categorized according to baseline baPWV levels using a cutoff value of 1800 cm/s. Incident functional dependency was defined as new certification under the Japanese long-term care insurance system. Cumulative incidence was assessed using Kaplan–Meier analysis, and associations were examined using Cox proportional hazards models adjusted for sex, hypertension, diabetes mellitus, obesity, and smoking status. Results: No significant difference in the cumulative incidence of functional dependency was observed between baPWV groups among early elderly participants (log-rank p = 0.944). In contrast, among late elderly participants, those with high baPWV exhibited a significantly higher cumulative incidence of functional dependency (log-rank p = 0.045). In multivariable-adjusted Cox models, high baPWV was not associated with incident functional dependency in the early elderly group (HR 0.820; 95% CI 0.340–1.976). However, in the late elderly group, high baPWV was independently associated with an increased risk of functional dependency (HR 1.978; 95% CI 1.013–3.864). Conclusions: Elevated baPWV is an independent predictor of incident functional dependency in community-dwelling late elderly adults, suggesting that the prognostic significance of arterial stiffness for functional decline is age-dependent. Assessment of arterial stiffness may enhance risk stratification beyond conventional blood pressure measures, particularly in advanced old age.